NPIMap

Organization Active NPI

South Shore Dental Prosthetic

  • Dentist
  • Quincy, MA
National Provider Identifier
1396035705
Registry record updated Apr 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
21265 Issued in MA
Legal business name
SOUTH SHORE DENTAL PROSTHETIC
Practice address
165 Washington St
Quincy, MA 02169-5514
Phone
(617) 471-1890
Fax
(617) 471-7310
NPI assigned
Apr 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Katarina Pavlicic, DMD
Title
President
Phone
(617) 471-1890

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 21265 MA Primary

Addresses

Primary practice location

165 Washington St
Quincy, MA 02169-5514

Mailing address

165 Washington St
Quincy, MA 02169-5514
Phone (617) 471-1890

National Provider Directory

National Provider Directory

Locations

165 Washington St
Quincy, MA 02169
Phone (617) 471-1890

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303171200000",
    "number": "1396035705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 WASHINGTON ST",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021695514",
            "telephone_number": "617-471-1890",
            "fax_number": "617-471-7310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 WASHINGTON ST",
            "city": "QUINCY",
            "state": "MA",
            "postal_code": "021695514",
            "telephone_number": "617-471-1890",
            "fax_number": "617-471-7310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH SHORE DENTAL PROSTHETIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-19",
        "last_updated": "2011-04-19",
        "status": "A",
        "authorized_official_last_name": "PAVLICIC",
        "authorized_official_first_name": "KATARINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-471-1890",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "21265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.